By E.J. Dionne, Jr.
SouthCoastToday, September 16, 2017

Before supporters of universal health coverage get all wrapped up debating a single-payer system, they need to focus on a dire threat to the Affordable Care Act likely to come up for a vote in the Senate before the end of the month.

The latest repeal bill is an offering from Sens. Lindsey Graham, R-S.C., and Bill Cassidy, R-La., that would tear apart the existing system and replace it with a block grant to the states. Block grants — flows of money for broad purposes with few strings attached — are a patented way to evade hard policy choices. All the tough decisions are kicked down to state capitals, usually with too little money to achieve the ends the block grant is supposed to realize.

This is a matter of urgency because the authority the Senate has to pass Obamacare repeal with just 51 votes expires on Sept. 30. So if the bill comes up, it would likely hit the floor in the last week of this month. All who care about the expansion of health care coverage need to focus their energies on defeating this latest attack on Obamacare. However we eventually arrive at universal coverage, which we must, it will be far easier to get there by building on the ACA.

And assuming the latest repeal effort fails, last week’s push for a single-payer system could come to be seen as a useful initiative provided that “Medicare for All,” as its supporters like to call it, is treated as a goal, not a litmus test. Defining the left pole of the health care debate is helpful, in part because it shows how fundamentally moderate Obamacare is. It is not, as many conservatives have claimed, anything close to a socialist scheme.

And for those whose objective is single-payer, there are many options available that could gradually open the way for it. As Medicare for All’s leading advocate, Sen. Bernie Sanders, I-Vt., noted in an underappreciated tweet in July: “In the short-term, to improve the Affordable Care Act, we should have a public option in 50 states and lower the Medicare age to 55.” Many progressives and moderates who favor universal coverage but are not yet sold on single-payer would embrace options of this sort. Such measures would help a lot of people immediately and make any move to single-payer less disruptive.

http://www.southcoasttoday.com…

***

Comment:

By Don McCanne, M.D.

This column by E.J. Dionne is important because it represents the current most prevalent view on health care reform, written by an intelligent, highly respected journalist with great credibility and uncompromising ethics. We need to listen to him.

The more immediate issue that Dionne discusses is the cruel Graham/Cassidy proposal that would take health care away from millions of people. Since action on this bill is imminent, he calls for focusing our energies on defeating it. He is right. The bill needs to be defeated.

The larger issue here is that he demonstrates where the progressive/liberal camp is headed on long term reform. He describes single payer Medicare for all as the left pole of the health care debate, showing “how fundamentally moderate Obamacare is” in comparison. He then mentions what we are hearing from a multitude of reform advocates – that “there are many options available.” He then dials in on the dual option that has now become so prevalent in the national reform dialogue: “we should have a public option in 50 states and lower the Medicare age to 55,” even quoting Bernie Sanders as the authoritative source for this concept.

It has been repeated so many times that a Medicare buy-in and a public option will lead to single payer that it has become a meme. Everyone knows it’s true, well… just because it is.

A Medicare buy-in would have almost no resemblance to the existing traditional Medicare program. It is much more likely that private plans similar to Medicare Advantage plans would be modified to fit a new market, though difficulties would remain in risk pool management, reinsurance, benefit design, and other features that would require the support of Congress, much as they are now supporting the Medicare Advantage plans to give them an advantage over the traditional Medicare program.

A public option would have basically the same problems – creating a plan which will be public in name only but structured like private plans, except that it would be stripped of essential features to avoid giving it an “unfair” advantage over competing private plans. In fact, this is what Congress did with the public option that was part of the Affordable Care Act before it was pulled from the legislation because of Joe Lieberman’s tantrum.

If we follow either or both of these routes we will end up not only with inferior plans but also with none of the efficiencies or benefits of a single payer system. That will then be used as “proof” that single payer cannot work in the United States. Any further transition to single payer would be aborted.

But then there will be other ways we can do it. We’ll just have to turn everything over to the private insurers, except for high risk patients whose care we taxpayers will have to fund. Then we will have the hybrid system which our progressive friends are clamoring for.

It doesn’t have to be this way, but it could happen unless we mobilize the masses.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

By Brian G. Arndt, M.D., John W. Beasley, M.D., Michelle D. Watkinson, M.P.H., Jonathan L. Temte, M.D., Ph.D., Wen-Jan Tuan, M.S., M.P.H., Christine A. Sinsky, M.D. and Valerie J. Gilchrist, M.D.
Annals of Family Medicine, September/October 2017

Primary care physicians spend nearly 2 hours on electronic health record (EHR) tasks per hour of direct patient care. Demand for non–face-to-face care, such as communication through a patient portal and administrative tasks, is increasing and contributing to burnout. The goal of this study was to assess time allocated by primary care physicians within the EHR as indicated by EHR user-event log data, both during clinic hours (defined as 8:00 AM to 6:00 PM Monday through Friday) and outside clinic hours.

From the Discussion

This study provides a validated mechanism for EHR task analysis using EHR system event logs to evaluate primary care physician workload. Our event logs indicate that family medicine physicians spend approximately 45% of their workday (4.5 hours) on the EHR. Direct observation data were consistent with this finding. The remaining 55% of the workday (5.5 hours) was spent on non-EHR activities such as direct patient care, team interactions and meetings, paperwork, e-mail, and other work. An additional 1.4 hours per day of EHR time was spent outside of clinic hours (before 8:00 AM or after 6:00 PM), including 51 minutes per weekend. This extra time equates to an average workday (excluding time providing care to patients in the hospital) of 11.4 hours, representing a considerable encroachment on physicians’ personal and family lives.

http://www.annfammed.org…

***

Comment:

By Don McCanne, M.D.

This is serious. In this study, not only did primary care primary care physicians spend almost half of their clinic hours on electronic health records (EHRs), outside of clinic hours they spent an average of an additional 7 hours and 51 minutes – the equivalent of an extra workday per week. Does this investment in time provide enough direct patient benefit to warrant it? Of course not.

We would hope that a single payer system would address this problem, but there is risk that the public stewards would rely heavily on EHRs for administrative purposes and for current data-intensive information technology trends.

Hopefully shifting the culture from the business-oriented medical/industrial complex to a patient-service environment, as should occur with implementation of a well-designed single payer system, would cause the stewards to wake up and take a serious look at such wasteful services that induce physician/nurse burnout and patient malcontentment.

Clearly, we cannot allow this to continue.

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

C-SPAN, September 13, 2017

(Following is a transcript of Dr. Danielle Martin’s comments, but I would highly recommend viewing the C-SPAN video instead – four minutes beginning at 21:00 – link below.)

Sen. Bernie Sanders: Last, but very much not least, is Dr. Danielle Martin. You know, I think that it is high time that we started taking a look at what countries around the world were doing in providing quality care all of their people in a far more cost effective way than we do, and one of examples of a single payer system that is working well, that is popular, is the Canadian system. Dr. Martin is a Canadian physician, health care administrator, and an associate professor at the University of Toronto. She is the author of a Canadian best selling book, “Better Now: Six Big Ideas To Improve Health Care for All Canadians.” Dr. Martin.

Dr. Danielle Martin: Thank you Senator.

I must say that I am very grateful that so many Americans are interested in learning about the experience of your Canadian neighbors under our single payer health care system, which we also call Medicare.

As a practicing doctor, a hospital administrator, and a citizen, I am so proud to be part if a system where access to doctor and hospital services is truly based on need, not ability to pay. And I’m not the only one. In public polls, 94 percent of Canadians say that our health care system is a source of personal and collective pride, even more than ice hockey! Single payer health care is a symbol to us of what it truly means to be Canadian, that we take care of each other.

My grandparents immigrated to Canada in the early 1950s like so many people who come to this country, hoping to build a better life for their kids. And at that time, there was no universal health coverage in Canada. So when my grandfather had his first heart attack in his early 40s, his world was shaken, and by the time he died nearly a decade later, the family was essentially bankrupted by medical bills. I know that this remains a reality for many in the United States today, but you should know that just north of your border, that kind of a situation is essentially unimaginable.

My generation of Canadians does not remember what it was like to worry about paying a doctor or hospital bill. And despite our challenges, which of course every country experiences, Canadians have a longer life expectancy, lower infant mortality rates, and fewer preventable deaths than in the United States.

Single payer health care is also, as you know, less expensive. In Canada, our administrative overhead is less than 2 percent in our public plan as compared to 18 percent in the private plans here in the U.S. We spend just under $5000 per capita in Canada to cover everyone. You spend nearly $10000 per capita and yet tens of millions of people are uninsured. But most importantly, when my patients are sick I do not need to ask if they have insurance or if they can afford to pay for my services. And throughout my pregnancy, and for the birth of my daughter in a world-class hospital, I was never asked for money, and I never received a bill. I just handed over this card – my Canadian health care card – to my doctor, and that was it.

I wish that all of my American neighbors could experience the same simplicity in their moments of need. And I hope that the American people will seize this opportunity to declare to each other and to the rest of the world that you do believe access to health care is a human right.

Thank you.

https://www.c-span.org…

***

Comment:

By Don McCanne, M.D.

Everyone included. Care based on need. Lower costs. No financial barriers to care. Better outcomes. Less administrative hassle. And greater pride than even for their ice hockey teams!

Are Americans all bonkers, that we continue to reject this?

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.

Physicians for a National Health Program, September 13, 2017

Physicians for a National Health Program (PNHP), a nonprofit research and education organization of 21,000 physicians, medical students and health professionals, welcomes Sen. Bernie Sanders’ single-payer bill, The Medicare for All Act of 2017. Replacing America’s fractured, for-profit health system with improved Medicare for all would provide comprehensive care for everyone, help rein in skyrocketing health costs, and deliver better medical outcomes. 

“Congressional leaders can no longer sit on the sidelines watching our broken health system cripple the economy,” said Carol Paris, M.D., president of PNHP. “Every year that we do nothing, health care costs swell by another 5.6%. The only way to both control costs and guarantee access to care is to eliminate the administrative waste and profiteering of the insurance industry.”

At $3.2 trillion per year, the U.S. spends nearly twice as much per capita as any other high-income country on health care, but scores poorly on life expectancy, infant and maternal mortality, and access to health services. Despite the improvements of the Affordable Care Act,  28 million Americans remain uninsured, according to the Census Bureau’s estimate released on Tuesday. Researchers estimate that 36,000 Americans die prematurely each year because they lack insurance. Sen. Sanders’ bill would reduce the number of uninsured to zero, allowing everyone to visit the doctor or hospital of their choice for medically-necessary care, including dental, vision and mental health services.

By eliminating the wasteful, profit-driven private insurance industry, a single-payer program would save the nation hundreds of billions annually on paperwork and profits. Physicians, who now spend an average of nine hours each week on administrative tasks like billing, could focus more time on patient care. Not surprisingly, a majority of American doctors now support Medicare for all.

Under Medicare for all, medical bankruptcy would be a thing of the past. Today, the crushing cost of health care is the top financial problem facing U.S. families. Even many of the insured face obstacles to care: More than half of all workers with employer plans face deductibles of $1,000 or more, and more than one-third of U.S. adults report difficulty paying premiums and deductibles. By untangling health care from employment, workers would be free to switch jobs or launch a new business without losing coverage.

Dr. Paris notes that incremental tweaks like subsidizing ACA premiums, or offering Medicare or Medicaid buy-ins, will do little to change long-term health or financial outcomes. “We’ve tried everything else,” said Dr. Paris. “Medicare for all is the only plan that will solve our nation’s growing health care crisis.”

In 2016, PNHP released its Physicians’ Proposal for Single-Payer Health Care Reform, a proposal based on decades of careful analysis and research. PNHP recommends several improvements to the Medicare for All Act that would save money and improve patient care, including global budgeting of hospitals and other health care institutions; the separation of capital and operating payments to hospitals and other health care institutions; full coverage of all medications, without copayment; the exclusion of investor-owned, for-profit health care providers; and the establishment of a national long-term care program.

“PNHP applauds Sen. Sanders and the thousands of grassroots advocates whose tireless advocacy has pushed single payer to the forefront of the national debate on health care,” said Claudia Fegan, M.D., PNHP’s national coordinator. “We look forward to working with Sen. Sanders to strengthen and advocate for this bill.”

https://pnhp.org…

Stay informed! Visit www.pnhp.org/qotd to sign up for daily email updates.